1. By Dr Salman Kareem 1st yr Resident PGDepartment of Psychiatry

2. Disorder of Memory 3. memory Seven stages in memory1. Adequate perception , comprehension, and response to the material to be learned.2. Short term storage3. Formation of durable trace4. Consolidation5. Recognition that certain materials need to be recalled6. Isolation of the relevant memory7. Using the recalled material 4. Types Memory is of 3 typesi. Sensoryii. Short termiii. Long term 5. Sensory type Registered for each of the sense and its purpose is tofacilitate the rapid processing of incoming stimuli sothat the comparison can be made with materialalready stored in short and long term memory. Fades within few seconds. Closely related to attention. 6. Short term memory Working memory/ primary memory For the storage of memory much longer than the fewseconds available to sensory memory. Aids the constant updating of ones surroundings. 7. Long term memory When memories are rehearsed in the short term theyare encoded in the long term memory. Encoding is a process of placing information into whatis believed to be a limitless memory reservoir. Storage of material in long term memory allows forrecall of events from the past and for utilization ofinformation learned through educational system. 8. Autobiographical memories- memories of eventsthat relate to oneself Flashbulb memories- specific type ofautobiographical memory in which the personbecomes aware of an emotionally arousing event. 9. Explicit memory Declarative/rational memory Patient is conscious that they are remembering. Hippocampus - stored 2 typesi.Episodic memory- memory of specific eventsii. Semantic memory- memory of abstract facts 10. Implicit Memory Procedural/skills Limbic system (amygdala + cerebellum) Performance of tasks such as typing, swimming and cutting a loaf of bread are also expressions of prior learning but there is no active awareness of memory is being reached in undertaking the particular skill. 11. Process of remembering has 4 partsi. Registrationii. Retentioniii. Retrievaliv. Recall 12. AMNESIA Partial or total inability to recall part experience andevents.1. Organic2. Psychogenic 13. Normal Memory failure If an item is not rehearsed the memory fades andtherefore cannot be retrieved. Normal memory decayProactive interference old memories interfere with newlearning and hence recall.Retroactive interference new memories interfere withlearning of new material. 14. 1) Psychogenic amnesia(i) Anxiety amnesia Psychogenic reactions Morbid anxiety- particularly in depressive illness. 15. (ii) Katathymic amnesia Motivated forgetting A set of ideas which are disturbing when conscious arerepressed in an attempt to avoid the affect which theywould otherwise produce. More persistent and circumscribed Conscious motivation to forget suppression orunconscious motivation primary repression. No loss of personal identity Hysteria Normal persons with painful memories 16. (iii) Hysterical Amnesia Dissociative amnesia There is a complete loss of memory and personalidentity but the patient can carry out complicatedpatterns of behavior and is unable to look afterhimself. Often associated with fugue or wandering state. More common in those with prior history of headinjury. 17. 2) ORGANIC AMNESIA(i)Acute coarse brain diseasePoor memory is due to disorders of perception and attention and the failure to make a permanent trace.Retrograde amnesiaAcute head injuryAmnesia which embraces the events just before the injuryDisturbance of short term memory loss 18. Post traumatic amnesia: the period between loss of consciousness and appearance of full awareness and memory duration is directly related to severity of the head injury. 19. Anterograde amnesiaEvents occurring after the injury.The patient is fully conscious ,but has no memory for the events which occur.Result of failure to make permanent traces.Seen in Alcoholic blackout Delirium Twilight state due to epilepsy Pathological drunkenness 20. Transient global amnesia A sudden onset of retrograde amnesia covering a period offew days upto several years. Perception and personal identity remain normal. An anterograde amnesia continues until recovery (up toseveral hours) The amnesia subsequently shrinks to a period of half to 5hours. Some pts there is evidence of ischemia in the territory ofthe posterior cerebral circulation The immediate cause is probably b/l temporal or thalamiclesions. 21. Sub acute coarse brain disease The pt is unable to register new memories. The memory disorder is characterized by inability to earnnew information (anterograde amnesia) and oldinformation (retrograde amnesia) Memories from remote past remains intact. Seen in Korsakoffs syndrome CVA Multiple sclerosis Head injury ECT 22. Chronic Coarse Brain disease The amnesia extends over many years. Ribots law of memory regression: In dementingillness the memory of recent events is lost before thememory for remote events. 23. Distortion of memories Paramnesia Falsification of memory by distortion.I.Distortion of recallII. Distortion of recognition. 24. Distortion of recall Retrospective falsification. Retrospective delusions Dlusion memories Confabulations 25. Retrospective falsification The subject modifies his memories in terms of his generalattitudes. Unintentional and dependent on persons currentemotional experiential and cognitive state. Seen in Normal people - degree of retrospective falsification isinversely related to the degree of insight and self criticism ofthe individual Hysterical personality Depressive illness Agitated depression Mania 26. Retrospective delusions The pt dates back his delusions. Could be regarded as delusional retrospectivefalsification. schizophrenia 27. Confabulations Pictorial thinking (Leonard) , Memory Hallucinations(Bleuler) A false description of an event , which is alleged to haveoccurred in the past. Filling in of gaps in memory by imagined or untrueexperiences. Diminishes as the impairment worsens. 2 broad patterns emerge embarrassed type in which thepatient tries to fill in gaps as memory as a result of anawareness of a deficit , fantastic type in which the lacunaeis filled by details exceeding the need of memoryimpairment. 28. Embarrased is more common. Seen in Organic states Hysterical psychopaths Amnestic syndrome Chronic schizophrenia 29. False memory- recollection of an event which did notoccur which the individual believes did take place. Screen memory- recollection that is partially true andpartially false. Pseudologia fantastica- fluent plausible lying thatoccurs in those without organic brain pathology suchas personality disorder of anti social and hystericaltype. 30. Munchausens syndrome- variant of pathological lying in which the individual presents to the hospital with bogus medical illness , complex medical histories and often multiple surgical scars. 31. Gansers Syndrome Voibereden/ approximate answers - Pt understands thequestion but deliberately avoids the correct answer Clouding of consciousness with disorientation Auditory and visual hallucination Amnesia during the period for which symptoms weremanifest. Seen in hysterical pseudo dementia Conversion symptoms Recent head injury Infection Severe emotional stress 32. Cryptamnesia- experience of not remembering thatone is remembering. Hyperamnesia Exaggerated registration, retentionand recall. 33. Disorders of recognition.Dj vu The subject has the experience that he has seen orexperienced the current situation before, although ithas no basis in fact. The sense of recognition is never absolute. Normal people Temporal lobe lesions 34. Jamais vu event that has been associated before isnot experienced with appropriate feelings offamiliarity. Dj entendu : feeling of auditory hallucination Deja pense new thought as having been previouslyoccurred. 35. Misidentification Positive misidentification Negative misidentification. 36. Positive misidentification Pt recognizes strangers as his friends and relatives Some pts assert that all of the people whom they meetare doubles of real people. Confusional state Acute schizophrenia Chronic schizophrenia 37. Negative misidentification Pt denies that his friends and relatives are peoplewhom they say they are and insists they are strangersin disguise Excessive concretization of memory images. 38. consciousness A state of awareness of the self and the environment. Active consciousness when the subject focuses hisattention on some internal or external event. Passive consciousness: when the same events attractthe subjects attention without any conscious effort onhis part. 39. Distractability Disturbance of active attention the pt is diverted by almost all new stimuli and habituationto new stimuli takes longer than usual. Seen in Fatigue Anxiety Severe depression Mania Schizophrenia Organic states 40. Orientation Capacity of a person to gauge accurately the time spaceand person in his current setting. Time Is labile Quite readily disturbed by rapt concentration. Strong emotion Organic brain factors. 41. Space Disturbed later than time Unable to find his way or place Person Patient fails to remember his own name and identity. Lost with greatest difficulty, 42. Ways which consciousness can be changed Dream like changes of consciousness Lowering of consciousness Restriction of consciousness 43. Dream like changes ofconsciousness There is a lowering of the level of consciousness whichis a subjective experience of a rise in the threshold forall incoming stimuli Pt is disoriented for time place , but not for person. Clinical features Visual hallucination Unable to distinguish between mental image andperceptions. 44. Disordered thinking as in dream showing excessivedisplacement, condensation and misuse of symbols. Auditory hallucinations common elementary rarelycontinuous voices, organized hallucinations take formoff odd disconnected words or phrases. Other hallucinations of touch , pain, electric feelings,muscle sense and vestibular sensations often occur. When underlying physical illness is severe, insomnia ismarked. 45. Occupational delirium : when the pt is restless andcarries out the actions of his trade. Subacute delirious state : mild degree of delirium ,where pt may have a general lowering of consciousnessduring the day and be incoherent and confused, whileat night delirium often occurs with visualhallucinations. 46. Lowering of consciousness Pt is apathetic, generally slowed down , unable toexpress himself clearly and may perseverate. After some weeks there is remarkable partial recoveryand the pt is left with mild organic defect. Seen in Severe infections, like typhoid and typhus Arteriosclerotic disease following CVA 47. Restriction of consciousness There is some lowering down of level of consciousnessand the awareness is narrowed down to few ideas andattitudes which dominate the pts mind. Twilight state : there is a A restriction of the morbidity changed consciousness A break in the continuity of consciousness Relatively well ordered behaviour. Commonest- epilepsy 48. Hysterical twilight state: the restriction of consciousness resulting from unconscious motives 49. The End